Development and validation of a nomogram for predicting survival in patients with acute pancreatitis.

BACKGROUND: Acute pancreatitis (AP) is a complex and heterogeneous disease. We aimed to design and validate a prognostic nomogram for improving the prediction of short-term survival in patients with AP. METHODS: The clinical data of 632 patients with AP were obtained from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The nomogram for the prediction of 30-day, 60-day and 90-day survival was developed by incorporating the risk factors identified by multivariate Cox analyses. RESULTS: Multivariate Cox proportional hazard model analysis showed that age (hazard ratio [HR]=1.06, 95% confidence interval [95% CI] 1.03-1.08, P<0.001), white blood cell count (HR=1.03, 95% CI 1.00-1.06, P=0.046), systolic blood pressure (HR=0.99, 95% CI 0.97-1.00, P=0.015), serum lactate level (HR=1.10, 95% CI 1.01-1.20, P=0.023), and Simplified Acute Physiology Score II (HR=1.04, 95% CI 1.02-1.06, P<0.001) were independent predictors of 90-day mortality in patients with AP. A prognostic nomogram model for 30-day, 60-day, and 90-day survival based on these variables was built. Receiver operating characteristic (ROC) curve analysis demonstrated that the nomogram had good accuracy for predicting 30-day, 60-day, and 90-day survival (area under the ROC curve: 0.796, 0.812, and 0.854, respectively; bootstrap-corrected C-index value: 0.782, 0.799, and 0.846, respectively). CONCLUSION: The nomogram-based prognostic model was able to accurately predict 30-day, 60-day, and 90-day survival outcomes and thus may be of value for risk stratification and clinical decision-making for critically ill patients with AP.

Association of Mild Thyroid Dysfunction and Adverse Prognosis Among Chinese Patients With Acute ST Segment Elevation Myocardial Infarction.

Aims: Thyroid hormones widely affect the cardiovascular system, but the effects of mild thyroid dysfunction on the clinical prognosis of patients with acute ST segment elevation myocardial infarction (STEMI) remains unclear. Our aims were to analyze the relations between mild thyroid dysfunction at admission and clinical outcomes in Chinese patients with STEMI. Methods: A total of 1,176 STEMI patients with the available data of thyroid function and follow-up were analyzed, including 348 patients with mild thyroid dysfunction [subclinical hypothyroidism (n=81), hyperthyroidism (SHyper) (n=51), and low triiodothyronine syndrome (LT3S) (n=216)] and 828 patients with euthyroid function. During a median 4.4-year follow-up, in-hospital mortality, cardiac and all-cause mortalities were subsequently compared among the four groups. Results: Compared with the euthyroid group, STEMI patients in the SHyper and LT3S groups faced obviously increased risks of in-hospital death [odds ratio (OR): 5.007, 95% confidence interval (CI): 1.246-20.124, p = 0.023 and OR: 2.491, 95% CI: 1.054-5.887, p = 0.037, respectively) even after adjustment for various confounding factors. During a median 4.4-year follow-up, STEMI patients with LT3S at baseline had higher cardiovascular mortality [hazard ratio (HR): 1.880, 95% CI: 1.178-2.998, p = 0.008] and all-cause mortality HR: 1.647, 95% CI: 1.072-2.531, p = 0.023] than those with euthyroid at baseline, whereas no significantly increased mortality was found for STEMI patients with SCH and SHyper at baseline. Conclusions: STEMI patients with SHyper at admission had increased risk of in-hospital mortality, and STEMI patients with LT3S at baseline had worse prognosis and higher incidences of in-hospital mortality and cardiovascular and all-cause deaths compared with euthyroid patients.

Effects of Maternal Subclinical Hypothyroidism in Early Pregnancy Diagnosed by Different Criteria on Adverse Perinatal Outcomes in Chinese Women With Negative TPOAb.

Aims: To compare the effects of maternal subclinical hypothyroidism (SCH) diagnosed by the 2011 or 2017 "Guidelines of the American Thyroid Association (ATA) for the diagnosis and management of thyroid disease during pregnancy and the postpartum" during the first trimester on adverse pregnancy outcomes in thyroid peroxidase antibody (TPOAb)-negative pregnant women. Methods: There were 1,556 Chinese singleton pregnant women with negative TPOAb diagnosed with either SCH or euthyroidism who were investigated, and the prevalence and risk of obstetric outcomes were compared between the two groups using 2011 and 2017 ATA standards, respectively. The effects of a mildly elevated thyroid-stimulating hormone (TSH) concentration on adverse pregnancy outcomes were evaluated by binary logistic regression. Results: Maternal SCH identified by the 2011 ATA guidelines correlated with higher rates and risks of pregnancy-induced hypertension (PIH), preeclampsia, and low-birth-weight infants, while maternal SCH diagnosed by the 2017 ATA guidelines was more likely to develop PIH, preeclampsia, cesarean delivery, preterm delivery, placenta previa, and total adverse maternal and neonatal outcomes. Moreover, a mildly elevated TSH level was significantly associated with PIH after adjustment for confounding factors. Conclusions: Compared with the 2011 ATA guidelines, the 2017 ATA guidelines could be more applicable to Chinese pregnant women to screen the effects of SCH on the majority of adverse pregnancy outcomes.

Circulating follicular helper T cells presented distinctively different responses toward bacterial antigens in primary biliary cholangitis.

Primary biliary cholangitis (PBC) is a chronic and progressive cholestatic liver disease with unknown causes. The initiation of PBC is associated with bacterial infections and abnormal immune correlates, such as the presence of self-reactive anti-mitochondrial antibodies and shifted balance of T cell subsets. In particular, the CD4+CXCR5+ follicular helper T (Tfh) cells are highly activated in PBC patients and are significantly associated with PBC severity, but the underlying reasons are unknown. In this study, we found that the circulating CD4+CXCR5+ T cells were enriched with the interferon (IFN)-γ-secreting Th1-subtype and the interleukin (IL)-17-secreting Th17-subtype, but not the IL-4-secreting Th2 subtype. We further demonstrated that a host of microbial motifs, including Pam3CSK4, poly(I:C), LPS, imiquimod, and CpG, could significantly stimulate IFN-γ, IL-17, and/or IL-21 from circulating CD4+CXCR5+ T cells in PBC patients, especially in the presence of monocytes and B cells. Whole bacterial cells of Escherichia coli, Novosphingobium aromaticivorans, and Mycobacterium gordonae, could also potently stimulate IFN-γ, IL-17, and/or IL-21 production from circulating CD4+CXCR5+ T cells. But interestingly, while the whole cell could potently stimulate circulating CD4+CXCR5+ T cells from both healthy controls and PBC patients, the cell protein lysate could only potently stimulate circulating CD4+CXCR5+ T cells from PBC patients, but not those from healthy controls, suggesting that circulating CD4+CXCR5+ T cells in PBC patients had distinctive antigen-specificity from those in healthy individuals. Together, these data demonstrated that bacterial antigen stimulation is a potential source of aberrant Tfh cell activation in PBC patients.

Costs, Trends, and Related Factors in Treating Lung Cancer Patients in 67 Hospitals in Guangxi, China.

Lung cancer is a common disease with high mortality in China. Recent economic advances have led to improved medical capabilities, while costs associated with treating this disease have increased. Such change contributes to a commonly held belief that healthcare costs are out of control. However, few studies have examined this issue. Here, we use 34,678 hospitalization summary reports from 67 Guangxi hospitals (period 2013-2016) to document costs, temporal trends, and associated factors. Findings from this study are surprising in that they debunk the myth of uncontrolled healthcare costs. In addition, results and experiences from Guangxi are informative for other comparable regions.

Evaluation of the clinical effect of small-volume resuscitation on uncontrolled hemorrhagic shock in emergency.

OBJECTIVE: The objective of the present study was to explore the resuscitative effect of small-volume resuscitation on uncontrolled hemorrhagic shock in emergency. METHODS: In this study, the resuscitative effects in 200 trauma patients with uncontrolled hemorrhagic shock in emergency were studied. Half of these patients were infused with hypertonic/hyperoncotic fluid (small-volume resuscitation group, n=100), whereas the rest were infused with Hespan and lactated Ringer's solution (conventional fluid resuscitation group, n=100). The changes in hemodynamics, coagulation function, blood biochemistry, blood hematology, and the average infusion volume in both the groups were comparatively studied. RESULTS: It was found that the hemodynamics were improved in both the groups after resuscitation. Interestingly, compared with trauma patients infused with Hespan and lactated Ringer's solution, the growth rate, range, and time duration of the mean arterial pressure of the patients in small-volume resuscitation group increased significantly, and the shock index decreased progressively; in the 60th min after the resuscitation, blood index including hemoglobin, hematocrit, red blood cells, white blood cells, and platelet declined, whereas prothrombin time and activated partial thromboplastin time were prolonged in both the groups, but these changes were less obvious in the small-volume group. In addition, the average infusion volume of patients in the small-volume group was less than that of patients in conventional fluid resuscitation group. CONCLUSION: Featured with small infusion volume and less influence to coagulation function and homeostasis of human body, small-volume resuscitation possesses a significantly higher resuscitative effect. Therefore, trauma patients may have a better chance to maintain the hemodynamic stability and the survival rate, or recovery speed will be increased when traditional aggressive fluid resuscitation is replaced by small-volume resuscitation.

Assessment of potential factors associating with costs of hospitalizing cardiovascular diseases in 141 hospitals in Guangxi, China.

BACKGROUND: The rising cost of healthcare is of great concern in China, as evidenced by the media features negative reports almost daily. However there are only a few studies from well-developed cities, like Beijing or Shanghai, and little is known about healthcare costs in rest of the country. In this study, we use hospitalization summary reports (HSRs) from admitted cardiovascular diseases patients in Guangxi hospitals during 2013-2016, and we investigate temporal trends of healthcare costs and associated factors. METHODS: By generalized additive model, we compute temporal trends of cost per stay (CPS), cost per day (CPD) and others. We then use generalized linear models to assess which factors associate with CPS and CPD. FINDINGS: Using a total of 760,000 HSRs, we find that CPS appears to be stabilized around $1040 until the middle of year 2015, before exhibiting a downward trend. Similarly, CPD exhibits similar stable pattern. Meanwhile, surgery-specific CPS showed an increase in year 2013-2014, and then stabilized. Drug costs account for over 1/3 of CPS, but they are gradually declining. Costs associated with physicians' and nurses' services represent less than 5% of CPS. We found that age, sex, marital status, occupation and payment methods are significantly associated with CPS or CPD. Interestingly, we found no association between patient ethnicity and these costs. However, we did find that minority patients use more secondary hospitals than Han patients. INTERPRETATIONS: Healthcare costs in Guangxi are stable, contrary to the rise portrayed by Chinese mass media. Several factors can be associated with healthcare costs, and these may be useful for developing evidence-based policies. In particular, there is a need to encourage more Han patients to seek care in primary and secondary hospitals.

The impact of predisposing, enabling, and need factors in utilization of health services among rural residents in Guangxi, China.

BACKGROUND: Healthcare in China has significantly improved, meanwhile many  socio-economic risk factors and health conditions factors affect accessibility and utilization of health services in rural areas. Inequity of health service in China needs to  be estimated and reduced. Andersen behavioral model is useful to assess the association of health service utilization with predisposing, enabling, and need factors. METHODS: A survey was conducted among 4634 residents of 897 households in 2012. Logistic regression analysis was performed to explore the association of predisposing (age, gender, marital status, ethnicity and family size), enabling (education level, travel time to the nearest health facility, medical expense per capita, and health insurance coverage), and need factors (chronic disease) with the utilization of health services (i.e. physician visit and hospitalization). RESULTS: We observed a significant association between need factor (chronic diseases) and health service unitization, after adjusting for all predisposing and enabling factors (physician visits: odds ratio (OR) = 5.87, 95 % confidence interval (CI) = 4.71-7.32; hospitalization: OR = 4.04, 95 % CI = 2.90-5.61, respectively). In addition, age, gender, marital status, family size and education level were significant predictors of health service utilization. The travel time to the nearest health facility was associated with the utilization of physician visits, and expenditure on healthcare was a hindering factor of hospitalization. CONCLUSIONS: The predisposing and enabling factors had a minor impact on health service utilization, while the need factor was a dominant predictor of health service utilization among rural residents in China.

High-normal urinary albumin-to-creatinine ratio is independently associated with metabolic syndrome in Chinese patients with type 2 diabetes mellitus: A cross-sectional community-based study.

AIMS/INTRODUCTION: Microalbuminuria is positively related to metabolic syndrome (MetS). Our aim was to investigate whether urinary albumin-to-creatinine ratio (UACR) within the normal range is independently associated with MetS in Chinese community-based patients with type 2 diabetes. MATERIALS AND METHODS: A total of 514 participants (206 males and 308 females; mean age 66 years) with UACR less than 3.5 mg/mmol were enrolled from two downtown areas of Shanghai. The participants were stratified into quartiles according to UACR levels. The prevalence of MetS was assessed and compared among the four groups by binary logistic regression. RESULTS: Compared with participants with UACRs in the first quartile, the other quartiles had a higher prevalence of MetS (65.9%, 74.4% and 81.3%, respectively, P = 0.001) after adjustment for sex and age. After adjusting for potential confounders, participants in the second to the fourth quartile group had a 1.36-, 1.84- and 2.73-fold risk of MetS, respectively, relative to those in the lowest quartile. Furthermore, UACR, whether as quartile groups or as a continuous variable, is an independent predictor of MetS after fully adjusting for other variables. CONCLUSIONS: These results suggest that UACR even within the normal range is independently associated with MetS in Chinese community-based patients with type 2 diabetes mellitus.

Significant sex-based outcome differences in severely injured Chinese trauma patients.

A body of experimental evidence suggests that the female sex is associated with a lower risk of mortality after trauma-hemorrhage. However, controversy remains regarding the mechanism responsible for these differences and if basic science findings correspond to clinical differences. Racial disparities in trauma outcomes have also been increasingly described. Until now, research on the association between sex and trauma patient outcomes mainly focused on patients in Europe and the United States. Our research attempted to determine whether the female sex is associated with a survival advantage among severely injured Chinese trauma patients. A retrospective analysis of data derived from the Emergency Intensive Care Unit of the Shanghai Sixth People';s Hospital Acute Trauma Center during 2010 to 2013 was performed to characterize differences in sex-based outcomes after severe blunt trauma. The patient study cohort (858 Asian subjects) was then stratified by age and injury severity (using the Injury Severity Score [ISS]). Crude and adjusted odds ratios (ORs) were calculated to evaluate the association between sex and nosocomial infection rate and hospitalized mortality, both overall and by age and ISS category subgroups. Among all trauma patients, females had a significantly lower risk of in-hospital mortality compared with males (OR, 0.41; 95% confidence interval [95% CI], 0.20 - 0.85). This difference was most apparent for patients younger than 50 years (OR, 0.31; 95% CI, 0.12 - 0.82) and the group with ISS scores of 25 or higher (OR, 0.39; 95% CI, 0.17 - 0.91). No differences in the development of nosocomial infections between sexes were seen among the overall patient group and subgroups. This study revealed a statistically significant association between sex and mortality among severe blunt trauma patients, particularly those patients younger than 50 years and with ISSs of 25 or higher. Women had significantly lower mortality than men after severe blunt trauma. These results highlight the important role of sex hormones and sex-based outcome differences after severe traumatic injury in the Chinese population.

Type-I interferon secretion in the acute phase promotes Cryptococcus neoformans infection-induced Th17 cell polarization in vitro.

Cryptococcosis is a potentially fatal fungal disease commonly identified in patients with acquired immunodeficiency syndrome. Cryptococcus infection induces strong pro-inflammatory cytokine secretion, i.e. type-I interferon (IFN-I) via the Toll-like receptor signaling pathway. However, innate immune responses are insufficient in host defense against fungi infection and the clearance of Cryptococcus is dependent on the T helper (Th)17 cell-mediated mucosal immune response. In this study, IFN-I was identified as the early response cytokine to Cryptococcus neoformans infection via quantitative PCR (qPCR) and IFN-I was demonstrated to be crucial for interleukin (IL)-17A secretion in T cells, but not in innate immune cells. In addition, blockade of IFN-I reduced the protein expression levels of IL-22 and IL-23 in Th17 cells in vitro. These results suggest additional functions of IFN-I in immune regulation, which may be pivotal for the development of clinical immune therapy.

Racial disparities and sex-based outcomes differences after severe injury.

BACKGROUND: Controversy exists about the mechanisms responsible for sex-based outcomes differences post-injury. X-chromosome-linked immune response pathway polymorphisms represent a potential mechanism resulting in sex-based outcomes differences post-injury. The prevalence of these variants is known to differ across race. We sought to characterize racial differences and the strength of any sex-based dimorphism post-injury. STUDY DESIGN: A retrospective analysis was performed using data derived from the National Trauma Data Bank 7.1 (2002-2006). Blunt-injured adult (older than 15 years) patients, surviving >24 hours and with an Injury Severity Score >16 were analyzed (n = 244,371). Patients were stratified by race (Caucasian, black, Hispanic, Asian) and multivariable regression analysis was used to characterize the risk of mortality and the strength of protection associated with sex (female vs male). RESULTS: When stratified by race, multivariable models demonstrated Caucasian females had an 8.5% lower adjusted risk of mortality (odds ratio [OR] = 0.91; 95% CI, 0.88-0.95; p < 0.001) relative to Caucasian males, with no significant association found for Hispanics or blacks. An exaggerated survival benefit was afforded to Asian females relative to Asian males, having a >40% lower adjusted risk of mortality (OR = 0.59; 95% CI, 0.44-78; p < 0.001). Asian males had a >75% higher adjusted risk of mortality relative to non-Asian males (OR = 1.77; 95% CI, 1.5-2.0; p < 0.001), and no significant difference in the mortality risk was found for Asian females relative to non-Asian females. CONCLUSIONS: These results suggest that Asian race is associated with sex-based outcomes differences that are exaggerated, resulting from worse outcomes for Asian males. These racial disparities suggest a negative male X-chromosome-linked effect as the mechanism responsible for these sex-based outcomes differences.

[The effect evaluation of a new tuberculosis management model in rural areas of Guangxi].

OBJECTIVE: To explore the effect of new model for tuberculosis (TB) control and management, and provide a scientific basis and justification for making TB control strategies in rural communities. METHODS: Among those townships with low TB service accessibility by the county TB control institute in Guangxi Xingye county (population of 679 thousands), four townships with total population of 152 518 and inconvenient transportation, were selected as the experimental group to conduct a new model research project.Based on the accessibility for community services, setting diagnosis and treatment management centers in township hospitals, employing family treatment supporters to supervise the treatment process. The TB cases of the base-line and the project expiration of the experimental group were 44 and 117. Meanwhile, three townships including Dapingshan, Longan and Gaofeng in the county with the similar condition and total population of 133 303 were selected as the control group. The control group conducted the provisions of national TB control program in the county TB clinic management. The TB cases of the base-line and the project expiration of the control group were 56 and 110. By double-direction comparison method, the effect of the new model was evaluated through TB patients detection, treatment outcomes and TB control management data. SPSS 13.0 statistical software was adopted and Chi-square test was used for analyzing technical data. RESULTS: After two-year project research implementation, in the experimental group the detection rate of new smear-positive TB patients increased from 16.39/100 000 (25/152 518) to 51.14/100 000 (78/152 518) (χ(2) = 27.281, P < 0.01), the cure rate of new smear-positive cases increased from 71.4% (15/21)to 91.1% (51/56) (χ(2) = 4.812, P < 0.05), and the completing treatment rate in newly diagnosed smear-negative cases improved from 23.5% (4/17)to 71.4% (15/21) (χ(2) = 8.622, P < 0.01); the loss rate of newly diagnosed smear-positive cases dropped from 23.8% (5/21) to 0.0% (0/56) (χ(2) = 10.608, P < 0.01), and the loss rate of newly diagnosed smear-negative cases decreased from 64.7% (11/17) to 4.8% (1/21) (χ(2) = 15.624, P < 0.01). Meanwhile, the cure rate of new smear-positive cases in the experimental group, 91.1% (51/56), was higher than the control group, 72.0% (36/50) (χ(2) = 6.531, P < 0.05). The loss rate of newly diagnosed smear-positive cases in the experimental group (0.0% (0/56)) was lower than the control group (16.0% (8/50)) (χ(2) = 7.534, P < 0.01). During the project implementation, in the experimental group the on time rate of taking medicine, 91.5% (107/117) and receiving medicine, 100.0% (117/117), the reexamining sputum ratio, 83.6% (98/117) were higher than that in the control group: 81.8% (90/110), 92.7% (102/110) and 64.5% (71/110). The differences were statistically significant (χ(2) = 4.589, 8.820 and 11.005, P < 0.05). CONCLUSION: The new management model had been proved effective. It can improve TB case detection and cure rates, reduce the loss rate of patients, and improve patient treatment and management conditions as well.

[Analysis of the risk factors for pesticide poisoning among children in countryside of Guigang city].

OBJECTIVE: This study was to investigate the risk factors for pesticide poisoning among rural children in Guigang. METHODS: A 1:4 matched case-control study was conducted. A total of 78 rural children who were hospitalized or visited the out-patient clinic due to pesticide poisoning in Guigang from January to December in 2009 were recruited as cases, and 312 matched controls were recruited during the same time. The children's parents or guardians were surveyed with a questionnaire. The questionnaire including general information and 21 possible risk factors concerned in family structure, guardian status, educational level of parents, average annual family income, family and school health education and dangerous behavior in children. The data were analyzed by conditional logistic regression analysis. RESULTS: Three risk factors and five protective factors were identified significantly associated with pesticide poisoning in rural children. The risk factors included inappropriate deposit of hydrocomion and contaminated working clothes (OR = 3.529, 95%CI: 1.408 - 8.848), playing outside frequently (OR = 2.846, 95%CI: 1.513 - 5.352), grandparents being children's guardian (OR = 2.187, 95%CI: 1.187 - 4.029). The protective factors included high frequency of guardianship (OR = 0.408, 95%CI: 0.205 - 0.811), knowledge for poisoning prevention (OR = 0.412, 95%CI: 0.224 - 0.758), washing working clothes in time (OR = 0.435, 95%CI: 0.212 - 0.893), taking health educational courses in school (OR = 0.448, 95%CI: 0.232 - 0.867) and teaching children non-access to toxic agents regularly (OR = 0.462, 95%CI: 0.227 - 0.939). CONCLUSION: Childhood pesticide poisoning accidence in countryside of Guigang was caused by multiple factors including children's risk behaviors, family factors, environmental factors and health education.

[An exploratory study on the diagnostic cutoff value of International HIV-associated Dementia Scale in minority ethnic groups with different educational levels, in Guangxi].

OBJECTIVE: Using Intelligence Scale of Mini Mental State Estimated (MMSE) as the gold standard to determine the relevance of International HIV-associated Dementia Scale (IHDS) in minority ethnic areas in Guangxi populations with different cultural values. Corresponding boundary value related to the authenticity and reliability on IHDS were also evaluated. METHODS: 200 patients with HIV infection were randomly selected from the minority ethnic groups in Guangxi. For each infected person, MMSE and IHDS blind scale were tested at the same period. Using the results from MMSE scale test as the gold standard, ROC curve and IHDS scale in Guangxi minority populations with different education levels which related to the diagnosis of dementia-HIV values were determined. The value of a specific sector under the IHDS sensitivity, specificity, and internal consistency coefficients was also evaluated. RESULTS: When considering the infected person did not differ on their educational level, the IHDS scale diagnostic cutoff appeared as 8.25, while IHDS sensitivity as 0.925, specificity as 0.731 and Kappa as 0.477 (P < 0.001). When considering the extent of cultural differences did influence the prevalence of infection, the different education groups showed different IHDS diagnostic cutoff values. People with high school, secondary school or higher education levels, the IHDS diagnosis appeared to be 8.25, when sensitivity was 0.917, specificity was 0.895 and Kappa was 0.722 (P < 0.001). People with only primary education level, the IHDS appeared to be 7.25. When sensitivity was 0.875, specificity was 0.661 and Kappa was 0.372 (P < 0.001). CONCLUSION: The IHDS diagnostic sector in Guangxi minority groups was lower than the internationally recommended level of diagnostic cutoff value (IHDS ≤ 10 points). When using IHDS to perform the HIV related dementia screening program, in the minority areas of Guangxi, culture context, the degree and difference of HIV infection should be considered, especially in using IHDS diagnostic cutoff values.

[Prevalence of hypertension in the Guangxi Bai Ku Yao populations].

OBJECTIVE: To observe the prevalence of hypertension and associated risk factors in the Guangxi Bai Ku Yao populations. METHODS: A total of 1170 subjects of Bai Ku Yao aged 15 and over were surveyed by a stratified randomized cluster sampling. Blood pressure, body height, weight, waist circumference, serum lipid and apolipoprotein levels were measured, and body mass index (BMI) were calculated, matched 1173 subjects of Han Chinese from the same region served as control. RESULTS: The standardized prevalence of hypertension in Bai Ku Yao was significantly lower than that in Han (11.53% vs.16.79%, P < 0.01). The mean levels of systolic, diastolic blood pressure, and pulse pressure in Bai Ku Yao were also significantly lower than those in Han [(115.7 +/- 16.3) vs. (120.0 +/- 16.3) mm Hg (1 mm Hg = 0.133 kPa), P < 0.01; (74.1 +/- 9.4) vs. (75.9 +/- 10.4) mm Hg, P < 0.01; and (41.6 +/- 12.0) vs. (44.2 +/- 11.2) mm Hg, P < 0.01; respectively]. Hypertension was positively correlated with male, age, physical activity, BMI, waist circumference, and the intakes of total energy, total fat, and sodium, and negatively associated with education level in both ethnic groups (P < 0.05 - 0.01), but was positively associated with alcohol consumption only in Han. The rates of awareness, treatment and control of hypertension were significantly lower in Bai Ku Yao than those in Han population [(11.81% vs. 21.76%), P < 0.05; (5.51% vs. 12.95%), P < 0.05; and (2.36% vs. 8.29%), P < 0.05; respectively]. CONCLUSION: The prevalence of hypertension was significantly lower in Bai Ku Yao population than in Han population and diet, low sodium intake, life style, and genetic factors might be responsible for the lower hypertension prevalence in Bai Ku Yao population.

Risk factors for childhood drowning in rural regions of a developing country: a case-control study.

BACKGROUND: Descriptive epidemiological studies have shown that childhood drowning rates are higher in developing countries, with an increasing trend in rural areas. AIM: To examine risk factors associated with childhood drowning in rural China. METHODS: Participants included parents of all children aged 1-14 years who died of drowning between 2002 and 2004 in 20 districts in GuangXi Province, and two age- and gender-matched controls each. Behavioral characteristics of the child and the children's caregivers were collected using a questionnaire and analyzed using logistic regression. RESULTS: Boys (60%) and children aged 1-4 years (48%) were over-represented among the cases; 62% occurred within 500 m of the school or home. Protective fencing or warning signs were found at only two sites. None of the children's caregivers knew how to perform cardiopulmonary resuscitation. For children aged 1-4 years significant risk factors included poor health of the caregiver (OR 3.1; 95% CI 1.9 to 5.8), not using flotation devices (OR 2.3; 95% CI 1.4 to 4.5) and no proper swimming lessons (OR 1.8; 95% CI 1.1 to 5.5). For children aged 5-14 years, the main risk factors were that the child did not have the experience of playing near or in water regularly (OR 2.7; 95% CI 1.8 to 7.4) and lack of close supervision (OR 1.9; 95% CI 1.3 to 5.6). CONCLUSION: Risk factors identified in this study suggest that childhood drowning in rural areas in developing countries could be prevented by providing safety educational programs, which should focus on constant adult supervision and the use of flotation devices when children play in and near water.

[A case-control study on risk factors of drowning among children aged between 1 and 14 in rural areas of Guangxi].

OBJECTIVE: To find out the risk factors of drowning among children aged 1 and 14 in rural areas and to provide evidence for prevention and to reduce such incidents. METHODS: 20 towns being selected as a cluster sampling study and screened out 133 drowning children aged 1-14 from Jan. 1, 2002 to Dec. 31, 2004 were screened. 1:2 matched case-control method was conducted. Data was analyzed with conditional univariate and multivariate logistic regression analysis. RESULTS: Results showed that falling into water took the leading type of drowning among children from the rural areas. The component of drowning displayed that boys was higher than girls. The majority occurred. during the warmer months, in summer and autumn. The places where drowning occurred was mainly at incidence site. Results from single and multiple factors analysis identified four major risk factors as: alcoholic drinking of his/her mother, lack of emergency treatment in the village, the child care-taker did not know what to do when drowning was occurring, the child usually played beside the water site. Factors preventing from drowning were: swimming training, the child caretaker keeping an eye on the child when he/she was swimming, the health condition of the caretaker and the communication with the parents. CONCLUSION: The risk factors of drowning among children aged 1-14 in rural areas were caused by multiple factors. Prevention and control program on drowning should be focusing on supervision, safety water, safety education and teaching swimming.